cisplatin

Posted on April 28th, 2009 by

Class: Chemotherapy

Generic Name: Cisplatin (sis-PLAT-in), CDDP
Trade Name: Platinol®, Platinol®-AQ

For which conditions is this drug approved? The FDA has approved cisplatin for the following conditions: metastatic testicular cancer in combination with other chemotherapy agents following appropriate surgery and/or radiation therapy; metastatic ovarian cancer in combination with other chemotherapy agents following appropriate surgery and/or radiation therapy, or as a single agent in metastatic ovarian cancer that has stopped responding to other standard chemotherapy agents; and advanced bladder cancer that is not suitable for surgery and/or radiation. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.

What is the mechanism of action? Cisplatin belongs to a group of drugs called alkylating agents. Cisplatin produces its anti-cancer effects by causing a chemical reaction that damages the DNA in a cell. The DNA damage caused by cisplatin results in cellular death.

How is cisplatin typically given (administered)? Cisplatin can be given intravenously (into a vein), or intraperitoneally (into the peritoneum of the abdominal cavity). If cisplatin escapes from the vein in which it is administered, it may cause serious damage to the tissue that it comes in contact with.  Although patients will be monitored for this, they should tell their healthcare provider immediately if they experience pain, redness or swelling at the site in which the drug is being administered. The way in which cisplatin is administered, as well as dosing and schedules is dependent upon many factors, including the condition being treated, the overall medical condition of the patient, the patient’s tolerance of treatment, the patient’s height and weight, and the particular treatment regimen being utilized. Extra intravenous fluid is given prior to and following administration of cisplatin to reduce side effects to the kidneys.

Patients may experience an allergic-type reaction within minutes of cisplatin administration consisting of wheezing, difficulty breathing and low blood pressure. Patients should tell their heathcare provider immediately if they experience any of these symptoms.

How are patients typically monitored? Patients will usually have scheduled meetings for follow-up during treatment with cisplatin. Typically, blood will be drawn to check levels of blood cells, and to monitor electrolyte levels and functions of some organ systems, such as the kidneys or liver. Kidney function tests and some electrolyte levels may be taken prior to each administration of cisplatin.

Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy. A neurologic exam, including testing reflexes, will be performed as cisplatin may result in loss of sensation in hands, feet or extremities.

Uncommonly, patients experience a type of allergic reaction to cisplatin. Patients will be closely monitored for this, but should notify their healthcare provider immediately if they experience difficulty breathing, a rapid heart rate, swelling of the face and/or lightheadedness. In addition, cisplatin may cause damage to tissues it comes into contact with if it should leak out of the vein through which it is being administered. Patients should notify their healthcare provider immediately if the area of administration becomes painful, red or swollen.

What are the common (occur in 30% or more of patients) side effects of treatment with cisplatin?

• Low white blood cell levels – increases risk of infection
• Low red blood cell levels – increases risk of anemia
• Low platelet levels – increased risk of bleeding
• Nausea and vomiting
• Abnormalities in electrolyte levels as demonstrated by blood tests
• Kidney damage, which is generally reversible

What are the less common (occur in 10% to 29% of patients) side effects of treatment with cisplatin?

• Numbness or tingling of the hands or feet or extremities
• Hearing loss
• Ringing of the ears
• Loss of appetite
• Abnormalities in taste (metallic taste)
• Abnormalities in liver function levels as determined by blood tests
• Infertility
• Hair loss

This is not a complete list of side effects. Some patients may experience other side effects that are not listed here. Patients may wish to discuss with their physician the other less common side effects of this drug, some of which may be serious.

Some side effects may require medical attention. Other side effects do not require medical attention and may go away during treatment. Patients should check with their physician about any side effects that continue or are bothersome.

What can patients do to help alleviate or prevent discomfort and side effects?

• Pay careful attention to the physician’s instructions and inform the physician of any side effects.
• Maintain adequate rest and nutrition.
• Wear sunscreen and protective clothing and try to minimize sun exposure.
• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)
• If possible, avoid large crowds or people who are sick or not feeling well, as this drug may leave some patients susceptible to infection.
• Wash hands often to reduce the risk of infection.
• Eat small meals frequently to help alleviate nausea.
• If patients have been prescribed an anti-nausea medication, they should be sure to take the prescribed doses.

Are there any special precautions patients should be aware of before starting treatment?

• Patients should inform their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
• Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.

When should patients notify their physician?

• Fever
• Chills
• Sore throat
• Flu or cold-like symptoms
• Cough
• Signs of infection (redness, swelling, pus, tenderness)
• Swelling of the ankles, feet or face
• Yellowing of the skin or eyes
• Changes in hearing
• Changes in vision
• Numbness or tingling of hands, feet or extremities
• Extreme and persistent fatigue
• Unexplained bleeding (nosebleeds, bruising, blood in urine, black tarry stools, etc)
• Prolonged nausea and vomiting
• Swelling, pain or redness in only one extremity
• No urine output, or drastically reduced urine output in a 24-hour period
• Difficulty breathing
• Noticable change in heart rate or rthythm
• Lightheadedness
• Blistering or persistent pain, redness or swelling at the site of drug administration

What is a package insert?
A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers.  A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug. By carefully reviewing the package insert, you will get the most complete and current information about how to safely use this drug. If you do not have the package insert for the drug you are using, your pharmacist or physician may be able to provide you with a copy.

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Tags: C, Chemotherapy

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